1073882510 NPI number — MRS. ANNA MARIA DOUGLAS FNP-C

Table of content: MRS. ANNA MARIA DOUGLAS FNP-C (NPI 1073882510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073882510 NPI number — MRS. ANNA MARIA DOUGLAS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGLAS
Provider First Name:
ANNA MARIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073882510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33509-1403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-301-9511
Provider Business Mailing Address Fax Number:
719-888-1760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 IRONWOOD FLATS CIR
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-301-9511
Provider Business Practice Location Address Fax Number:
719-888-1760
Provider Enumeration Date:
12/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  21744 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APN.0990332-NP , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN11016580 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)